Apparent life-threatening events in infants

Background

The incidence of infant apparent life-threatening event (ALTE) was reported as 0.6-2.4 per 1000 live birth. The difficulty of the diagnosis lies in the delicate interpretation of the results of the clinical examination and the complementary examinations. The objectives of this study were to describe epidemiological, clinical and paraclinical characteristics of infants hospitalized for ALTE and to determine the most common diagnosis.

Methods

We conducted a case serie from January 2013 to April 2018 in the pediatric ward 2 at Abderrahim Harrouchi Children's Hospital, Casablanca of all infants aged less than 2 years hospitalized for malaise (newborn excluded). We obtained our data using a standardized form of service. We described our data by mean, frequency and percentages using SPSS 16.

Results

The mean age of onset of symptomatology is 4.8 months. Recurrence of discomfort was present in 30% of cases. The socio-economic conditions were unfavorable in more than half of the cases (63.3%). Clinical examination was abnormal in 6.6% of cases. Complementary examinations performed systematically in all patients were Blood cell count, blood ionogram, CRP, blood glucose and chest x-ray. Other examinations were performed according to the history and the clinic data. The most common diagnosis was gastroesophageal reflux (36.7%), cardiac problems (16.7%), lower respiratory tract infection (13.3%), and ‘'unknown'' (26.6%).

Conclusions

Few complementary examinations are systematically needed and their performance is increased if they are oriented by a careful history and physical examination which then allows to advance in the diagnostic procedure.

Key messages

Complementary examinations are largely inconclusive and only a history and complete clinical examination can make it possible to advance in the diagnostic procedure. Infants who demonstrate historical or physical examination elements suggestive of a specific etiology of their event, such as gastroesophageal reflux, should be evaluated and treated accordingly.

Exergy of passive states: Waste energy after ergotropy extraction

Work extraction protocol is always a significant issue in the context of quantum batteries, in which the notion of ergotropy is used to quantify a particular amount of energy that can be extracted through unitary processes. Given the total amount of energy stored in a quantum system, quantifying wasted energy after the ergotropy extraction is a question to be considered when undesired coupling with thermal reservoirs is taken into account. In this paper, we show that some amount of energy can be lost when we extract ergotropy from a quantum system and quantified by the exergy of passive states. Through a particular example, one shows that ergotropy extraction can be done by preserving the quantum correlations of a quantum system. Our study opens the perspective for new advances in open system quantum batteries able to explore exergy stored as quantum correlations.

Long non-coding RNA ANRIL polymorphisms in papillary thyroid cancer and its severity

Background: Long non-coding RNAs are likely to have a role in the pathogenesis of many diseases, including cancer. We hypothesised an effect of certain ANRIL single nucleotide polymorphisms (SNPs) in papillary thyroid cancer. Methods: Genomic ANRIL SNPs in rs11333048, rs4977574, rs1333040 and rs10757274 were determined in 134 papillary thyroid cancer patients and 155 age- and sex-matched controls. Results: None of the ANRIL SNPs were individually linked to papillary thyroid cancer. However, the AAAC haplotype (A from rs11333048, A from rs4977574, A from rs1333040 and C from rs10757274, respectively) showed a protective effect from papillary thyroid cancer whilst the CAAC and CAGT haplotypes were associated with cancer. The rs1333048 CC variant was more frequent in patients with larger tumour size (≥1 cm) in a recessive model (OR 3.4 [95%CI, 1.1-11], P = 0.035). The rs4977574 AC variant was associated with smaller tumour size in an over-dominant model (OR 0.4 [95%CI, 0.2-1.0], P = 0.041). SNPs in rs10757274 (AA: p = 0.045) and rs1333040 (CC: p = 0.019) are linked to a lower likelihood of III-IV cancer stages in dominant or codominant models. Conclusions: Certain haplotypes of ANRIL SNPs are associated with papillary thyroid cancer. ANRIL rs1333048 and rs4977574 variants were associated with larger and smaller tumour sizes, respectively. rs10757274 and rs1333040 variants might lead to lower III-IV cancer stages. These SNPs may be important in the diagnosis of this form of thyroid cancer.

Entanglement, coherence, and charging process of quantum batteries

Quantum devices are systems that can explore quantum phenomena, such as entanglement or coherence, for example, to provide some enhancement performance concerning their classical counterparts. In particular, quantum batteries are devices that use entanglement as the main element in their high performance in powerful charging. In this paper, we explore quantum battery performance and its relationship with the amount of entanglement that arises during the charging process. By using a general approach to a two- and three-cell battery, our results suggest that entanglement is not the main resource in quantum batteries, where there is a nontrivial correlation-coherence tradeoff as a resource for the high efficiency of such quantum devices.

The entropy production for thermal operations

According to the first and second laws of thermodynamics and the definitions of work and heat, microscopic expressions for the non-equilibrium entropy production have been achieved. Recently, a redefinition of heat has been presented in [Nature Communications volume 8, Article number: 2180 (2017)]. Since thermal operations play an important role in the resource theory of thermodynamics, it would be very interesting to find out the effect of the above-mentioned definition on the expression of the entropy production for these kind of operations. This is one of the aims of the present paper. Using the new definition of heat, it is shown that the entropy production is the same as the mutual information between a system and a bath both for thermal operations and, if the system-bath initial state is factorized, for entropy-preserving operations. It is also discussed that how one can recognize the type of the correlation between a system and a bath through knowledge of the initial state of the system only. It is shown that if the initial state of a system is diagonal in the energy basis, the thermal operations cannot create a quantum correlation between the system and the bath, however, if the system initial state is coherent Gibbs state, there cannot be classical correlation due to the thermal operations.

The effect of CASP3 rs4647610 and rs4647602 polymorphisms on tumour size and cancer stage in papillary thyroid carcinoma

BACKGROUND

Papillary thyroid carcinoma (PTC) is the most frequent form of thyroid cancer whose incidence has increased in recent years. Dysregulated apoptosis is known in the pathogenesis of various cancers. Caspase-3 is an important apoptotic component and its abnormal function may play a key role in cancer pathogenesis. We tested the hypothesis of a link between CASP3 single nucleotide polymorphisms rs4647610 and rs4647602 on PTC and its clinical outcomes.

MATERIAL AND METHODS

A total of 134 PTC patients and 151 healthy controls were genotyped for CASP3 rs4647610 and rs4647602 single nucleotide polymorphisms (SNPs) using PCR-RFLP method.

RESULTS

Allele and genotype frequencies of both SNPs were not different between cases and controls. The combined genotypes and haplotypes were not linked to PTC. However, the frequencies of CASP3 rs4647610 GA and AA genotypes were higher in PTC patients with larger tumour size (≥1 cm), and the rs4647610 SNP was associated with increased tumour size in the dominant model (OR 3.4 [95% CI, 1.1-11], P = 0.04). The CASP3 rs4647602CA and AA genotypes were higher in PTC patients with lower TNM stage (I-II) compared to higher stages (III-IV). No association was observed between CASP3 polymorphisms and other PTC outcomes.

CONCLUSION

Although CASP3 rs4647610 and rs4647602 SNPs are not associated with PTC, rs4647610 is linked to larger tumour size, and rs4647602 to lower stage of cancer.

A 3D printed drug delivery implant formed from a dynamic supramolecular polyurethane formulation

Prototype drug eluting implants have been 3D printed using a supramolecular polyurethane-PEG formulation. The implants are capable of releasing a pharmaceutical active with effective drug release over a period of up to 8.5 months.

The quantum thermodynamic force responsible for quantum state transformation and the flow and backflow of information

Why do quantum evolutions occur and why do they stop at certain points? In classical thermodynamics affinity was introduced to predict in which direction an irreversible process proceeds. In this paper the quantum mechanical counterpart of the classical affinity is found. It is shown that the quantum version of affinity can predict in which direction a process evolves. A new version of the second law of thermodynamics is derived through quantum affinity for energy-incoherent state interconversion under thermal operations. we will also see that the quantum affinity can be a good candidate to be responsible, as a force, for driving the flow and backflow of information in Markovian and non-Markovian evolutions. Finally we show that the rate of quantum coherence can be interpreted as the pure quantum mechanical contribution of the total thermodynamic force and flow. Thus it is seen that, from a thermodynamic point of view, any interaction from the outside with the system or any measurement on the system may be represented by a quantum affinity.

Crocus sativus L. versus Citalopram in the Treatment of Major Depressive Disorder with Anxious Distress: A Double-Blind, Controlled Clinical Trial

Introduction: Saffron (Crocus sativus L.) has demonstrated antidepressant effects in clinical studies and extensive anxiolytic effects in experimental animal models.

Methods: 66 patients with major depressive disorder accompanied by anxious distress were randomly assigned to receive either saffron (30 mg/day) or citalopram (40 mg/day) for 6 weeks. Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) were used to assess treatment effect during the trial.

Results: 60 participants finished the study. Patients who received either saffron or citalopram showed significant improvement in scores of the Hamilton Rating Scale for Depression (P-value<0.001 in both groups) and Hamilton Rating Scale for Anxiety (P-value<0.001 in both groups). Comparison of score changes between the 2 trial arms showed no significant difference (P-value=0.984). Frequency of side effects was not significantly different between the 2 groups.

Discussion: The present study indicates saffron as a potential efficacious and tolerable treatment for major depressive disorder with anxious distress.

Comparison of Saffron versus Fluoxetine in Treatment of Mild to Moderate Postpartum Depression: A Double-Blind, Randomized Clinical Trial

Introduction: Postpartum depression is a common mental health problem that is associated with maternal suffering. The aim of this double-blind clinical trial was to compare safety and efficacy of saffron and fluoxetine in treatment of mild to moderate postpartum depression. Methods: This was a 6-week, double-blind, randomized clinical trial. Subjects were women aged 18-45 years with mild to moderate postpartum depression who had Hamilton Depression Rating Scale (HDRS 17-item) score≤18. Eligible participants were randomized to receive either a capsule of saffron (15 mg capsule) or fluoxetine (20 mg capsule) twice daily for 6 weeks. The primary outcome measure was to evaluate efficacy of saffron compared to fluoxetine in improving depressive symptoms (HDRS score). Results: There was no significant effect for time×treatment interaction on HDRS score [F (4.90, 292.50)=1.04, p=0.37] between the 2 groups. 13 (40.60%) patients in the saffron group experienced complete response (≥50% reduction in HDRS score) compared with 16 (50%) in the fluoxetine group and the difference between the 2 groups was not significant in this regard (p=0.61). Frequency of adverse events was not significantly different between the treatment groups. Discussion: The results of this study may suggest that saffron is a safe alternative medication for improving depressive symptoms of postpartum depression. Nevertheless, it should be mentioned that the trial is not well powered and should be considered a preliminary study. Therefore, large clinical trials with longer treatment periods and comparison with placebo group would be appropriate for future studies.

Low-Dose Gabapentin in Treatment of High-Altitude Headache

Headache is the most prevalent symptom of acute mountain sickness. We conducted a pilot clinical trial at an altitude of 3500 m to evaluate the efficacy of gabapentin in treatment of high-altitude headache (HAH). Twenty-four adult HAH patients (10 female, 14 male; age 18–50 years) were randomly assigned to receive either 300 mg of gabapentin capsule or identical placebo. After 1 h the presence of HAH and need to receive supplementary analgesic were assessed. The duration of the HAH-free phase after taking additional analgesic was also registered. Four patients in the gabapentin group asked for additional analgesics, whereas nine placebo recipients did not find primary medication satisfactory after the first hour of treatment ( P = 0.04). The mean HAH-free period was 17.10 h in the gabapentin group, which was significantly higher than in the placebo group with a mean of 10.08 h ( P = 0.02). This preliminary observation indicates that gabapentin is effective in treatment and alleviation of HAH.

Biomarkers identified from serum proteomic analysis for the differential diagnosis of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves different organs. Its most important feature is the production of specific autoantibodies against nuclear or cytoplasmic antigens. Proteomic analysis of serum, as one of the most readily available body fluids, can be used as a method for clarifying the pathogenesis of SLE. In this study the serum proteome of 13 patients with SLE was evaluated and compared with seven healthy control participants. A specific kit was used to remove high-abundance proteins. After depletion, the protein expression patterns created by two-dimensional gel electrophoresis (2-DE) and MALDI-TOF/TOF-MS were used to identify disease-associated proteins. We found differential expression of 15 protein spots, including seven up-regulated and eight down-regulated proteins in SLE samples, in comparison with healthy participants. These spots were identified by MALDI-TOF/TOF-MS and classified into three groups include keratins, apolipoproteins and albumin, and individual proteins such as transthyretin, haptoglobin and prothrombin. These findings can help to clarify the pathophysiology and mechanism of SLE.

Association between the CD14 gene C-159T polymorphism and serum soluble CD14 with pulmonary tuberculosis

BACKGROUND

Functional C-159T polymorphism in the promoter region of the CD14 lipopolysaccharide receptor has been reported to be associated with the development of tuberculosis (TB).

OBJECTIVE

To assess the association of CD14 C-159T polymorphism and serum soluble CD14 (sCD14) levels with pulmonary tuberculosis (TB) in an Iranian population living in a TB-endemic area.

DESIGN

A case-control study was performed prospectively on 120 newly diagnosed pulmonary TB patients and 131 healthy subjects. C-159T polymorphism was performed using amplification refractory mutation system polymerase chain reaction (ARMS-PCR). Concentrations of sCD14 were measured in serum samples using enzyme-linked immunosorbent assay.

RESULTS

The genotype frequencies of C-159T polymorphism differed significantly between TB patients and controls (P = 0.006). The risk of TB was 2.3-fold greater in individuals with the T-allele (CT + TT) in comparison to those without (OR 2.3, 95%CI 1.2-4.3, P = 0.006). Mean total sCD14 was significantly increased in the serum of patients with newly diagnosed pulmonary TB (mean ± SD = 3177 ± 751 ng/ml) compared to healthy controls (mean ± SD = 2955 ± 424 ng/ml, P < 0.004).

CONCLUSION

These data indicate that the C-159T polymorphism of the CD14 gene is associated with TB; serum sCD14 levels were higher in TB patients in a sample of the Iranian population.

Dynamic Response of Intraocular Pressure and Biomechanical Effects of the Eye Considering Fluid-Structure Interaction

The vibration characteristics of shell structures such as eyes have been shown to vary with intraocular pressure (IOP). Therefore, vibration characteristics of the eye have the potential to provide improved correlation to IOP over traditional IOP measurements. As background to examine an improved IOP correlation, this paper develops a finite element model of an eye subject to vibration. The eye is modeled as a shell structure filled with inviscid pressurized fluid in which there is no mean flow. This model solves a problem of a fluid with coupled structural interactions of a generally spherically shaped shell system. The model is verified by comparing its vibrational characteristics with an experimental modal analysis of an elastic spherical shell filled with water. The structural dynamic effects due to change in pressure of the fluid are examined. It is shown that the frequency response of this fluid-solid coupled system has a clear increase in natural frequency as the fluid pressure rises. The fluid and structure interaction is important for accurate prediction of system dynamics. This model is then extended to improve its accuracy in modeling the eye by including the effect of the lens to study corneal vibration. The effect of biomechanical parameters such as the thicknesses of different parts of the eye and eye dimensions in altering measured natural frequencies is investigated and compared to the influence of biomechanical parameters in Goldmann applanation tonometry models. The dynamic response of the eye is found to be less sensitive to biomechanical parameters than the applanation tonometry model.

Adenosine deaminase activity in fertile and infertile men

Adenosine deaminase (ADA; E.C.3.5.4.4) catalyses the deamination of adenosine to inosine. In the human reproductive system, the importance of enzymes that affect metabolism of adenosine, particularly adenosine deaminase, has been noticed. The purpose of this study was to determine the plasma activities of total adenosine deaminase (ADAT), and its isoenzymes, ADA1 and ADA2, in fertile and infertile men. Plasma activities of ADA and its isoenzymes were measured in 55 fertile men and 70 infertile men. There was a significant difference in the ADA1 and ADA2 activities between fertile and infertile individuals (P < 0.01). The activity of ADAT, ADA2 and ADA1 in infertile men was higher than that in fertile individuals. This alteration in ADA activity can lead to reduced adenosine levels, which may be involved in disturbing the fertility process.

Long-term multilineage expression in peripheral blood from a Moloney murine leukemia virus vector after serial transplantation of transduced bone marrow cells

Using a mouse bone marrow transplantation model, the authors evaluated a Moloney murine leukemia virus (MMLV)-based vector encoding 2 anti-human immunodeficiency virus genes for long-term expression in blood cells. The vector also encoded the human nerve growth factor receptor (NGFR) to serve as a cell-surface marker for in vivo tracking of transduced cells. NGFR(+) cells were detected in blood leukocytes of all mice (n=16; range 16%-45%) 4 to 5 weeks after transplantation and were repeatedly detected in blood erythrocytes, platelets, monocytes, granulocytes, T cells, and B cells of all mice for up to 8 months. Transgene expression in individual mice was not blocked in the various cell lineages of the peripheral blood and spleen, in several stages of T-cell maturation in the thymus, or in the Lin(-/lo)Sca-1(+) and c-kit(+)Sca-1(+) subsets of bone marrow cells highly enriched for long-term multilineage-reconstituting activity. Serial transplantation of purified NGFR(+)c-kit(+)Sca-1(+) bone marrow cells resulted in the reconstitution of multilineage hematopoiesis by donor type NGFR(+) cells in all engrafted mice. The authors concluded that MMLV-based vectors were capable of efficient and sustained transgene expression in multiple lineages of peripheral blood cells and hematopoietic organs and in hematopoietic stem cell (HSC) populations. Differentiation of engrafting HSC to peripheral blood cells is not necessarily associated with dramatic suppression of retroviral gene expression. In light of earlier studies showing that vector elements other than the long-terminal repeat enhancer, promoter, and primer binding site can have an impact on long-term transgene expression, these findings accentuate the importance of empirically testing retroviral vectors to determine lasting in vivo expression.

Hematologic recovery in mice transplanted with bone marrow stem cells expressing anti-human immunodeficiency virus genes

We have used a mouse bone marrow transplantation (BMT) model to study the safety of retrovirus-mediated transfer of anti-HIV genes (RevM10 and HIV-1 pol antisense) into hematopoietic stem/progenitor cells (HSPCs). In particular, we have monitored the hematologic recovery post-BMT and transgene expression in myeloid and lymphoid lineages, and analyzed tissue sections for evidence of any transgene-related pathological condition. Expression of anti-HIV genes had no effect on kinetics of hematologic recovery post-BMT. The average time to reach 20% of normal cell counts was 15-17 days for white blood cells and 12-14 days for platelets, and the average time to reach complete recovery was 42-56 days for leukocytes and 104-161 days for platelets. Hematocrit levels were not significantly affected by irradiation and transplantation procedures. Donor chimerism was uniformly > or =90% in all transplanted animals. At 4-5 weeks post-BMT transgene expression was detected in peripheral blood leukocytes in 100% of the animals and ranged from 4.5 to 44.7%. In a majority of the animals the percentage of transgene-expressing cells in circulation decreased over time but remained detectable for the length of the study (>6 months). Expression was detected in all analyzed cell lineages (RBCs, platelets, monocytes, granulocytes, and T and B cells). Relative counts of various leukocytes (Mac1+ monocytes, Gr1+ granulocytes, CD3+ T cells, and B220+ B cells) were normal. There were no treatment-related histopathological changes in a wide range of tissues examined. In addition, there were no treatment effects on differential leukocyte counts, and morphology of peripheral blood and bone marrow brush smears. In summary, transfer and expression of the RevM10 and the HIV-1 antisense genes into hematopoietic stem/progenitor cells in vivo appears safe. We propose that the mouse bone marrow transplantation model could be used to evaluate some safety aspects of HSPC-based gene therapies.

HIV-1-induced thymocyte depletion is associated with indirect cytopathogenicity and infection of progenitor cells in vivo

Direct and indirect cytopathic mechanisms have been proposed to account for the loss of CD4+ T cells after infection with human immunodeficiency virus type 1 (HIV-1). We report here that HIV-1 infection of the human thymus in vivo results in thymocyte depletion by at least two different mechanisms. Thymocytes within multiple stages of differentiation are induced to die of apoptosis; most of these cells are uninfected. Additionally, thymopoiesis is interrupted by direct infection and destruction of intrathymic CD3-CD4+CD8- progenitor cells. These mechanisms are differentially induced by distinct isolates of HIV-1.

HIV induces thymus depletion in vivo

Human immunodeficiency virus (HIV) disease is typified by declining CD4+ T lymphocyte counts in the peripheral circulation, a loss which may be secondary to accelerated destruction, to suppressed differentiation, and/or to sequestration of circulating cells into tissue spaces. As it is hard to distinguish between these possibilities in human subjects, the pathogenic mechanisms associated with HIV infection are unclear. In particular, little is known about the events that occur within infected lymphoid organs in which most CD4 T lymphocytes mature and function. To obtain a better description of HIV pathogenesis in vivo, we have implanted human haematolymphoid organs into the immunodeficient SCID mouse to create the SCID-hu mouse. We have previously shown that these organ systems promote long-term multilineage human haematopoiesis and are permissive for infection with HIV. Here we report that human thymopoiesis is suppressed by HIV infection, thereby precluding regeneration of the peripheral T-cell compartment.

Human cytomegalovirus in a SCID-hu mouse: thymic epithelial cells are prominent targets of viral replication

Animal models of human cytomegalovirus (CMV) infections have not been available to study pathogenesis or to evaluate antiviral drugs. Severe combined immunodeficient mice implanted with human fetal tissues (SCID-hu) were found to support CMV replication and may provide a model for this species-specific virus. When conjoint implants of human fetal thymus and liver were inoculated with a low-passage-number isolate of CMV, strain Toledo, consistent high-level viral replication was detected 5, 12, 15, 28, and 35 days after inoculation and virus replication continued for up to 9 months. Other human tissue implants, including lung and colon, were also found to support viral growth but with greater variability in levels and for a shorter duration. As expected, the species specificity of human CMV was preserved in this model such that virus was detected in the human conjoint thymus/liver implant but not in surrounding mouse tissues. The majority of virus-infected cells were localized in the thymic medulla rather than cortical region of the implant and immunofluorescence analysis identified epithelial cells rather than any hematopoietic cell population as the principal hosts for viral replication. Finally, treatment of infected animals with ganciclovir reduced viral replication, thereby demonstrating the value of this system for evaluating antiviral therapies. This animal model opens the way for a range of investigations not previously possible with human CMV.

Cloned natural suppressor cell lines express the CD3+CD4-CD8- surface phenotype and the alpha, beta heterodimer of the T cell antigen receptor

Several cloned lines of natural suppressor (NS) cells were studied for their expression of the TCR complex. Almost all bore the CD3+CD4-CD8- surface phenotype with the alpha, beta TCR as judged by immunofluorescent staining. Immunoprecipitation experiments showed a spot on two-dimensional gels which is characteristic of the TCR heterodimer, but neither gamma- nor delta-chains could be precipitated with the appropriate antibodies. NS cells were stimulated to proliferate in vitro with anti-CD3 antibodies and PMA in the presence of irradiated spleen cells. However, anti-CD3 antibodies did not inhibit the suppressive activity of the NS cells. The role of the TCR complex in the suppressive function of these cells remains to be elucidated.

Cloned natural suppressor cell lines express the CD3+CD4-CD8- surface phenotype and the alpha, beta heterodimer of the T cell antigen receptor

Several cloned lines of natural suppressor (NS) cells were studied for their expression of the TCR complex. Almost all bore the CD3+CD4-CD8- surface phenotype with the alpha, beta TCR as judged by immunofluorescent staining. Immunoprecipitation experiments showed a spot on two-dimensional gels which is characteristic of the TCR heterodimer, but neither gamma- nor delta-chains could be precipitated with the appropriate antibodies. NS cells were stimulated to proliferate in vitro with anti-CD3 antibodies and PMA in the presence of irradiated spleen cells. However, anti-CD3 antibodies did not inhibit the suppressive activity of the NS cells. The role of the TCR complex in the suppressive function of these cells remains to be elucidated.